Tricuspid regurgitation

Definition

Tricuspid regurgitation is a disorder in which the heart's tricuspid valve does not close properly, causing blood to flow backward (leak) into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.

Alternative Names

Tricuspid insufficiency

Causes, incidence, and risk factors

The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right atrium).

The most common cause of tricuspid regurgitation is enlargement of the right ventricle, which pumps blood to the lungs, where it picks up oxygen. This enlargement may be a complication of any disorder that causes extra strain on the right ventricle.

Tricuspid regurgitation may also be caused or made worse by problems with the valves on the left side of the heart (mitral or aortic valve) or the left ventricle (which pumps blood from the heart to the rest of the body). It may also be due to any cause of pulmonary hypertension (high pressure in the lung circulation).

Other diseases can directly affect the tricuspid valve. The most common of these is infective endocarditis, which is usually due to unsanitary conditions during drug abuse. Anything that causes bacteria to enter the bloodstream can also cause endocarditis.

Tricuspid regurgitation may be found in people with a type of congenital heart disease called Ebstein's anomaly.

Other, less common causes of tricuspid regurgitation include:

Carcinoid tumors, which release a hormone that damages the valve

Marfan syndrome

Injury

Rheumatoid arthritis

Radiation therapy

Rheumatic fever

Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-Phen" (phentermine and fenfluramine) or dexfenfluramine.

Symptoms

Tricuspid regurgitation may not cause any symptoms if the regurgitation is not severe. However, patients may have:

Signs and tests

The health care provider may find abnormalities when gently pressing with the hand (palpating) on your chest. The doctor may also feel a pulse over your liver. The physical exam may show liver and spleen swelling.

Listening to the heart with a stethoscope may reveal a murmur or other abnormal sounds. There may be signs of fluid collection in the abdomen.

An ECG or echocardiogram may show enlargement of the right side of the heart. Doppler echocardiography or right-sided cardiac catheterization may be used to measure blood pressure inside the heart and lungs.

Other tests, such as CT scan or MRI of the chest (heart), may reveal enlargement of the right side of the heart and other changes.

Treatment

Treatment may not be needed if there are few or no symptoms. You may need to go to the hospital to diagnose and treat severe symptoms.

Swelling may be managed with medications (diuretics) that help remove fluids from the body.

Conditions that cause this problem should be identified and treated. Some people may be able to have surgery to repair or replace the tricuspid valve. Surgery is usually done as part of another procedure.

People with abnormal or damaged heart valves are at risk for an infection called endocarditis. Anything that causes bacteria to get into your bloodstream may lead to this infection. Steps to avoid this problem include:

Avoid unclean injections

Treat strep infections promptly to prevent rheumatic fever

Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Guidelines recommend the use of antibiotics for some patients, but only under certain conditions.

Expectations (prognosis)

Treating any conditions, especially high blood pressure in the lungs and swelling of the right lower heart chamber, may correct this disorder. Surgical valve repair or replacement usually provides a cure. However, persons with severe tricuspid regurgitation that cannot be corrected may have a poor prognosis, either from this condition or the one that caused it.